Medical Therapy for Hypercortisolism (Cushing Syndrome)

Medical Therapy for Hypercortisolism (Cushing Syndrome)

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By, Dr. Jagruti Parikh, Endocrinology

Cushing syndrome occurs when your body is exposed to high levels of the hormone cortisol for a long time. Cushing syndrome sometimes called hypercortisolism, may be caused by the use of oral corticosteroid medication in conditions like asthma, inflammatory bowel disease, eczema etc.

The condition may also be due to your body’s own overproduction of cortisol (endogenous Cushing syndrome). This may occur from excess production by one or both adrenal glands, or overproduction of the adrenocorticotropic hormone (ACTH), which normally regulates cortisol production like in pituitary tumours, adrenal tumours, ectopic ACTH tumours. Too much cortisol can produce some of the hallmark signs of Cushing syndrome — a fatty hump between your shoulders, a rounded face, and pink or purple stretch marks on your skin. Cushing syndrome can also result in high blood pressure, bone loss and, on occasion, type 2 diabetes.

Symptoms 
The signs and symptoms of Cushing syndrome can vary depending on the levels of excess cortisol.

Common signs and symptoms involve progressive obesity and skin changes, such as:

  • Weight gain and fatty tissue deposits, particularly around the midsection and upper back, in the face (moon face), and between the shoulders (buffalo hump)
  • Pink or purple stretch marks (striae) on the skin of the abdomen, thighs, breasts and arms
  • Thinning, fragile skin that bruises easily
  • Slow healing of cuts, insect bites and infections

Acne

Women with Cushing syndrome may experience:

  • Thicker or more visible body and facial hair (hirsutism)
  • Irregular or absent menstrual periods

Men with Cushing syndrome may experience:

  • Decreased libido
  • Decreased fertility
  • Erectile dysfunction

Other signs and symptoms include: 

  • Severe fatigue
  • Muscle weakness
  • Depression, anxiety and irritability
  • Loss of emotional control
  • Cognitive difficulties
  • New or worsened high blood pressure
  • Headache
  • Bone loss, leading to fractures over time
  • In children, impaired growth

With effective treatment, cortisol levels will gradually stabilize and symptoms will eventually improve. It should be noted that the earlier you receive treatment, the better the outcome.

Treatment- 
Depending upon the cause of the syndrome, treatment may vary accordingly. The design, however, of all treatment methods is to help lower excessive layers of cortisol hormone in your body. Here are a few possible treatment options:

  1. Decreasing the Use of Corticosteroids: A long-term use of corticosteroid medications is a leading factor in causing Cushing’s syndrome. If this is the case, you can help improve symptoms either by reducing the dosage over a period of time or by taking prescribed non-corticosteroid drugs.
  2. Surgery: If tumors are the cause, your doctor will most probably recommend a complete surgical removal. If the tumor originates in the lungs, pancreas or adrenal glands, it can be surgically removed either by standard operation or by using minimally invasive surgical techniques with relatively smaller incisions.
  3. Radiation Therapy: Radiation therapy is recommendable only if your pituitary gland cannot be removed completely or if you are not eligible for surgery.
  4. Medications: If neither surgery nor radiation therapy works, you may have to resort to taking specific medications to help control cortisol production.